New-Onset Left Ventricular Dysfunction After Left Bundle Branch Pacing.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2024-08-30 DOI:10.1016/j.jacep.2024.07.019

Shunmuga Sundaram Ponnusamy, Vithiya Ganesan, Sudharshana Nagalingam, Vadivelu Ramalingam, Selvaganesh Mariappan, Habibullah Moghal, Senthil Murugan, Mahesh Kumar, Riya Joseph, Pugazhendhi Vijayaraman

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引用次数: 0

Abstract

Background: Left bundle branch pacing (LBBP) provides stable pacing parameters and has been suggested as an alternative for right ventricular pacing and cardiac resynchronization therapy.

Objectives: The aim of the study was to assess the incidence and etiology of new-onset left ventricular dysfunction (NOLVD) following LBBP in patients with baseline normal left ventricular (LV) function and cardiomyopathy patients with normalized LV function.

Methods: Patients undergoing successful LBBP for symptomatic bradyarrhythmia or as an alternative to cardiac resynchronization therapy were included. Normalization of LV function was defined as improvement in LV ejection fraction to ≥50%. Patients with baseline normal LV function and those with recovered LV function after LBBP constituted the study group. Loss of conduction system capture (LOCSC) was defined as complete or partial loss of right bundle branch delay pattern along with inability to demonstrate capture transition during threshold assessment.

Results: A total of 426 patients were included; 59% (n = 250) had baseline normal LV function (group I) and 41% (n = 176) had recovered LV function after LBBP (group II). Mean follow-up duration of 28.3 ± 16.7 months. NOLVD was noted in 3.75% (n = 16; group I = 5 and group II = 11) of patients. The etiologies for NOLVD were LOCSC in 62.5% (n = 10), suboptimal atrioventricular (AV) delay in 18.7% (n = 3), atrial fibrillation in 6.3% (n = 1), and idiopathic in 12.5% (n = 2). LOCSC occurred at a mean interval of 9.2 ± 6.4 months after the initial implantation. Reinterventions (n = 6) including lead repositioning, AV delay optimization, and AV junction ablation resulted in renormalization of LV function in all 6 patients.

Conclusions: Periodic assessment in device clinic is required because NOLVD from reversible causes can occur during follow-up in patients after LBBP.

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左束支起搏后新发左心室功能障碍

背景：左束支起搏（LBBP）可提供稳定的起搏参数，已被建议作为右心室起搏和心脏再同步化治疗的替代方法：研究旨在评估左束支起搏后新发左心室功能障碍（NOLVD）的发生率和病因，研究对象为基线左心室（LV）功能正常的患者和左心室功能正常的心肌病患者：方法：纳入因症状性缓慢性心律失常或作为心脏再同步化治疗的替代方案而成功接受 LBBP 的患者。左心室功能正常化的定义是左心室射血分数改善到≥50%。基线左心室功能正常的患者和 LBBP 后左心室功能恢复的患者组成研究组。传导系统捕获丧失（LOCSC）的定义是右束支延迟模式完全或部分丧失，以及在阈值评估中无法显示捕获转换：共纳入 426 名患者；59%（n = 250）的患者左心室功能基线正常（I 组），41%（n = 176）的患者在 LBBP 后左心室功能恢复（II 组）。平均随访时间为 28.3 ± 16.7 个月。3.75%的患者（n = 16；I 组 = 5，II 组 = 11）出现 NOLVD。NOLVD的病因包括：62.5%的患者为LOCSC（10例），18.7%的患者为房室延迟不达标（3例），6.3%的患者为心房颤动（1例），12.5%的患者为特发性（2例）。LOCSC 发生在首次植入后的平均间隔时间为 9.2 ± 6.4 个月。重新干预（n = 6）包括导联重新定位、房室延迟优化和房室交界处消融，所有 6 名患者的左心室功能均恢复正常：需要在设备诊所进行定期评估，因为 LBBP 患者在随访期间可能会出现由可逆原因引起的 NOLVD。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.